Provider Demographics
NPI:1255648564
Name:ADVANTICARE HOME HEALTH SERVICES,LLC
Entity type:Organization
Organization Name:ADVANTICARE HOME HEALTH SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOLITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEGAY-YAZZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-292-5222
Mailing Address - Street 1:PO BOX 11353
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87192-0353
Mailing Address - Country:US
Mailing Address - Phone:505-292-5222
Mailing Address - Fax:505-292-5333
Practice Address - Street 1:3620 WYOMING BLVD NE
Practice Address - Street 2:SUITE 130
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3297
Practice Address - Country:US
Practice Address - Phone:505-292-5222
Practice Address - Fax:505-292-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM60238569Medicaid